The purpose of this research is to evaluate the dissemination and implementation of the Agency for Health Care Policy Research (AHCPR) Guideline for Urinary Incontinence (UI) in nursing home settings. Management of UI is an important concern to the quality of life and well- being of many Americans living in the community and in nursing homes. It is estimated that more than half a million nursing home residents have UI. The cost of management of UI in nursing homes alone is estimated to be in excess of 7 billion dollars annually. With the - release of the AHCPR UI Guideline in 1992, the potential now exists for a significant multidisciplinary effort to improve the quality of management of UI in nursing homes. Yet it is unknown to what degree, if any, the UI Guideline has been effectively disseminated to providers and nursing home staff and to what degree it has actually been implemented. This proposal will evaluate the UI practices in 52 nursing homes (6,949 beds) in a nine county area of Upstate New York by physicians, nurse practitioners, clinical nurse specialists, physicians assistants, nursing staff and nurses aides. First, the level of awareness, knowledge, and attitude toward the Guideline will be determined and related to various dissemination strategies. Then actual practice will be evaluated in 200 cases of new urinary incontinence to determine the degree to which the UI Guideline is being applied in nursing homes. Separate analyses will be done to determine if there has been improvement over pre-UI Guideline in 12 nursing homes where data was collected earlier by the investigators. In addition, the study will identify barriers to implementation of the Guideline and estimate resource implications for its implementation through the use of focus groups of providers and nursing home staff. This study represents an unusual opportunity to learn about the process of and barriers to effective dissemination of practice guidelines involving multiple disciplines in a health care setting that is very appropriate for application of many clinical practice guidelines.